The present invention relates to a suture guiding device, specifically, but not limited to, the type used during a radical prostatectomy procedure or anastomosing two tubular structures.
At the present time, there are few suture guide techniques. For many years surgeons have been using a Foley catheter, perineal pressure, or traction suture to facilitate the placement of the suture 10 during anastomosis of the urethra to the bladder neck. The retraction of the short urethral stump has made this a technical challenge.
More recently suture guides have been developed to improve the anastomosis.
For example, the device described in U.S. Pat. No. 2,897,820, (Robert Tauber) is used to ligate tissue structures by guiding the curved needle after it has passed through body tissue or anastomosing large diameter tubular structures, but it is not suitable to anastomose the urethral stump because of the physical constraints of the male body. His device can place sutures only in one location. This makes it impossible to place subsequent sutures around the urethral stump.
U.S. Pat. No. 4,911,164 (Robert A. Roth) describes a suture guide that is a modification of the standard urethral sound as Dr. Robert W. Taylor shows in his 1904 edition of Practical Treatise On Genito-Urinary Venereal Diseases And Syphilis book. Roth's device includes at least one groove which extends from the tip of the sound into the curved portion of the sound. However, if only one deep groove is provided, a suture can be placed only in one position with respect to the stump because the suture guide cannot be rotated inside the male urethra. Thus, if more than one suture location is required, it is necessary to withdraw the sound from the patient and replace it with another sound containing a groove in a different location which is then reinserted into the patient. It is necessary to repeat this procedure as many times as the number of sutures required. Obviously, this is time-consuming and technically cumbersome. As it can be seen in Roth's illustration, if more than one groove is placed around the sound, this configuration will require very shallow grooves. These shallow grooves will guide the needle at an angle that will cause it to embed deep into the surrounding tissue as it advances through the urethral stump. The retrieval of the needle then becomes very difficult. Roth attempted to solve the problem of urethral stump retraction by adding expanding elements to push the urethral stump outward. However, this addition to the guide risks potential damage to the urethral stump by tearing the urethral tissue. Other patents, such as U.S. Pat. No. 5,053,043 (James E. Gottesman), show suture guiding devices which incorporate an interchangeable, freely rotatable tip on a urethral sound. Mr Gottesman's invention does not have a slit in the tip of his suture guide. Furthermore, rotation of the tip cannot be controlled externally but instead requires manipulation of the tip inside the body cavity at the suture end. Since the tip is freely rotatable, it is difficult to stabilize during suture placement.